PRAIRIELANDS COUNCIL APPLICATION FOR SUMMER CAMP EMPLOYMENT Applicants are not required to give any information on this form that is prohibited by federal, state, or local law. This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Applicants accepted for employment are on a trial basis with a probationary period and if, in our judgment, it is found during this period that the employee is not adapted to the work assigned, or that the information given has been misrepresented, the employment may be terminated without reason. In connection with your application for employment, an investigation may be made requesting information as to character and general reputation. Information as to the nature and scope of any investigation requested will be furnished to you, upon your written request. ______________________________________________________________________________________________________ FIRST NAME MIDDLE NAME LAST NAME _______________________________________________________________________________________________________ ADDRESS CITY STATE ZIP _______________________________________________________________________________________________________ E-MAIL ADDRESS PHONE NUMBER Program Director * Must Be---- Highest educational institution attended?______________________ Aquatics Director* *21 or older Dates attended____________________degree___________ Aquatics Instructor **18 or older Scoutcraft Director** Have you attended a BSA National Camping School in the last five Scoutcraft Instructor years, if so when and where?_______________________________ First Year Campers Director Certificate obtained?________________________________ First Year Campers Instructor Do you hold any Red Cross certificates? (Please list the Handicraft Director** expiration dates)__________________________________________ Handicraft Instructor ________________________________________________________ Poncho Pond Director** _______________________________________________________ Poncho Pond Instructor High Adventure Director* Are you currently registered as a Scout or Scouter?____________ Sports Director Position?__________________________Rank?________________ Ecology Director ** Other Scouting positions held previously? Ecology Instructor _______________________________________________________ Field Sports Director* _______________________________________________________ Field Sports Instructor _______________________________________________________ Archery Director** Exact dates you will be available for employment? Health Officer* From_____________________to________________________ Assistant Ranger (Maintenance) Camp Commissioner* PREVIOUS EMPLOYERS and/or PERSONAL REFERENCES Dining Hall Stewart -LIST THREE- Dining Hall Worker INCLUDE PHONE NUMBERS PLEASE Trading Post Assistant ______________________________________________________ Counselor-In-Training ______________________________________________________ Other________________________________ ______________________________________________________ BOY SCOUTS OF AMERICA AN EQUAL OPPORTUNITY EMPLOYER Staff Experience:_______________________________________________________________________________________________ _____________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ Summer Camps Attended:_________________________________________________________________________________________ ______________________________________________________________________________________________________________ Special Interests & Hobbies:_______________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ General Skills Merit Badges Earned Scout Experience Story Telling First Aid Order of the Arrow Song Leader Emergency Prep NLS/NOAC Skits Camping Lodge Officer Campfire Emcee Cooking National Jamboree Games Leader Life Saving Philmont/Sea Base Hike Master Swimming BSA Lifeguard Cooking Specialist Wilderness Surv. Jr. Leader Training Conf. Innertube Boatswain Pioneering Religious Award Sports_____________ Nature 50 Mile Foot-A-Float Musical Instrument Canoeing Totin' Chip __________________ Archery WHY DO YOU WANT TO WORK AT CAMP? _______________________________________________________ Applicant's Signature and Date _______________________________________________________ If under 18, Parent's Signature.